Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal

Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST follow...

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Autores principales:	Sofia Sousa, Diogo Rocha, Joelma C. Silva, Ana Isabel Ribeiro, Guilherme Gonçalves, Álvaro Almeida, Ana Maria Correia, Raquel Duarte, Carlos Carvalho
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier España 2021
Materias:	Tuberculin Skin Test Interferon-Gamma Release Assays Cost-effectiveness Latent tuberculosis Screening Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/d3a8ca5a8a8442b7ba8fa83d4ff9defe
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spelling	oai:doaj.org-article:d3a8ca5a8a8442b7ba8fa83d4ff9defe2021-11-06T04:33:43ZComparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal2531-043710.1016/j.pulmoe.2021.04.002https://doaj.org/article/d3a8ca5a8a8442b7ba8fa83d4ff9defe2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S253104372100091Xhttps://doaj.org/toc/2531-0437Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. Materials and Methods: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. Results: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. Conclusions: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases.Sofia SousaDiogo RochaJoelma C. SilvaAna Isabel RibeiroGuilherme GonçalvesÁlvaro AlmeidaAna Maria CorreiaRaquel DuarteCarlos CarvalhoElsevier EspañaarticleTuberculin Skin TestInterferon-Gamma Release AssaysCost-effectivenessLatent tuberculosisScreeningDiseases of the respiratory systemRC705-779ENPulmonology, Vol 27, Iss 6, Pp 493-499 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tuberculin Skin Test Interferon-Gamma Release Assays Cost-effectiveness Latent tuberculosis Screening Diseases of the respiratory system RC705-779
spellingShingle	Tuberculin Skin Test Interferon-Gamma Release Assays Cost-effectiveness Latent tuberculosis Screening Diseases of the respiratory system RC705-779 Sofia Sousa Diogo Rocha Joelma C. Silva Ana Isabel Ribeiro Guilherme Gonçalves Álvaro Almeida Ana Maria Correia Raquel Duarte Carlos Carvalho Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal
description	Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. Materials and Methods: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. Results: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. Conclusions: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases.
format	article
author	Sofia Sousa Diogo Rocha Joelma C. Silva Ana Isabel Ribeiro Guilherme Gonçalves Álvaro Almeida Ana Maria Correia Raquel Duarte Carlos Carvalho
author_facet	Sofia Sousa Diogo Rocha Joelma C. Silva Ana Isabel Ribeiro Guilherme Gonçalves Álvaro Almeida Ana Maria Correia Raquel Duarte Carlos Carvalho
author_sort	Sofia Sousa
title	Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal
title_short	Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal
title_full	Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal
title_fullStr	Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal
title_full_unstemmed	Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal
title_sort	comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in portugal
publisher	Elsevier España
publishDate	2021
url	https://doaj.org/article/d3a8ca5a8a8442b7ba8fa83d4ff9defe
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Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal

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